Provider Demographics
NPI:1598178048
Name:POOLE, REGINA (LMHC, LPC, LPCMH)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:LMHC, LPC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9526 ARGYLE FOREST BLVD
Mailing Address - Street 2:STE B2 #354
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222
Mailing Address - Country:US
Mailing Address - Phone:904-570-5982
Mailing Address - Fax:
Practice Address - Street 1:1910 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6771
Practice Address - Country:US
Practice Address - Phone:904-570-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011252101YP2500X
SC7339101YP2500X
FLMH13350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional